News

May 14, 2012

Medi-Cal primary care physicians will receive a two-year, $11 billion pay increase, under a proposal released last week by U.S. Department of Health and Human Services. The proposal, which implements a provision of the Affordable Care Act (ACA), would on average result in a 50 to 60 percent increase in Medi-Cal rates for primary care physicians, including family medicine, pediatrics and internists, plus related subspecialties. The ACA calls for Medicaid payments to primary care physicians to be raised to Medicare levels for 2013 and 2014.

The increase, effective in 2013 and 2014, bring Medicaid payments to primary care physicians in line with those for Medicare. Although Medicaid is jointly funded by states and the federal government, the increase would be paid for entirely by the feds.

“The payment increase proposed today will be an important tool for states to ensure their primary care networks are prepared for increased enrollment as the health care law is implemented,” said Marilyn Tavenner, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), in a statement issued last Wednesday. “Today’s action will help encourage primary care physicians to continue and expand their efforts to provide checkups, preventive screenings, vaccines and other care to Medicaid beneficiaries.”

The California Medical Association (CMA) has been working closely with CMS to ensure that the definition of primary care used is as broad as possible. CMA believes this two-year pay increase is a step in the right direction; however, it is critical that we find a long-term solution that will ensure that the influx of new Medi-Cal patients will be able to find a doctor.

"This two-year pay bump will certainly prevent many primary care physicians from leaving the program," said Elizabeth McNeil, CMA Vice President of Federal Government Relations. "But it may not be enough to attract new physicians." Some primary care physicians will not want to enroll in the program and establish patient relationships, only to have to pull out in two years and leave their patients, she says.

CMA applauds Congress for recognizing that Medicaid reimbursement rates need to be improved to ensure access to care in California’s Medi-Cal program. Currently, California's rates rank 47th in the nation and are on average 50 percent below Medicare rates. Because of these low rates, two-thirds of California’s physicians cannot afford to participate in the program and more than 50 percent of Medi-Cal patients report they can’t find a doctor.